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Ministers act on GPs’ concerns around ACR availability



Ministers are reviewing its current policies concerning provision of NICE-recommended lab tests for diagnosing kidney disease in Wales following concerns raised by local GP leaders about their lack of availability. 

The Welsh Government said there was a ‘significant cost implication’ in following the NICE guidance on providing urine albumin: creatinine ratio tests for early detection of hypertension or chronic kidney disease, and it is reviewing the evidence base for the recommendation after problems were raised by LMCs.

Both Bro Taf LMC and North Wales LMC had said that there was funding for people with diabetes for the test – which detects and identifies proteinuria – but not for those with hypertension or renal problems, which meant GPs cannot conform to NICE recommendations.

NICE guidance on assessing and managing kidney disease recommends that ‘to detect and identify proteinuria, use urine ACR in preference to protein: creatinine ratio (PCR) because it has a greater sensitivity than PCR for low levels of proteinuria.’

Further NICE guidance states that all patients with hypertension should be offered a test for the presence of protein in the urine by ‘sending a urine sample for estimation of the albumin: creatinine ratio and test for haematuria using a reagent strip.’

But a Welsh Government spokesperson said: ‘Providing the test is not a problem. However, there is a significant cost implication in introducing it to a new patient group when the patient numbers are high and tests would need annual repeat.’

He added: ‘Bro Taf LMC wrote to the Specialist Standing Advisory Group in Clinical Chemistry (SSAGCC), a sub-committee of the Welsh Scientific Advisory Committee, to ask that this change be routinely provided. The SSAG have replied that they are reviewing this and re-evaluating the evidence base.’

A Bro Taf LMC spokesperson said: ‘GPs cannot follow current NICE guidance because the ACR test is not available locally for patients with hypertension. In Wales, ACR is only available for diabetics and there is no funding available to provide ACR for monitoring hypertension or renal disease.’

North Wales LMC chair Dr Eamonn Jessup said: ‘Everything points to ACR being a better early monitor of kidney damage than the PCR urine test. However, purely based on money the pathology lab in North Wales refuse to roll it out as the norm in spite of it being recognised as the far superior test.

’This is short-sighted and like so many tests the restriction of availability in the short term causes excess morbidity in the medium to long term.’